Community Pharmacies Research Articles

INdependenT prEscribinG in community phaRmAcy; whaT works for whom, why and in what circumstancEs (INTEGRATE): Realist review study protocol

Introduction The last decades have witnessed a series of initiatives in the United Kingdom (UK) to enhance patient access to quality care including access to medicine without compromising patient’s safety. Pharmacist independent prescribing is one of the initiatives introduced in 2006 with the intention of making more effective use of the skills and competencies of health professionals. Community pharmacy has a key role in the NHS long-term plan since pharmacies offer convenient and accessible sources of healthcare advice for the public. This role is more evident with the introduction of prescribing for all qualified pharmacists at the point of registration starting 2026. This realist review aims to explore how does independent prescribing in community pharmacy works, for whom, in what circumstances and how. Method and analysis Realist research seeks to explore and explain complex social interventions by utilising programme theories providing causal explanations of outcomes in terms of context-mechanism-outcome configurations. INTEGRATE will progress through six stages. In the first stage, we will partner with Patient, Public, Involvement and Engagement Group (PPIE) and Practitioner Stakeholder Group (SG), to further scrutinise the review’s focus. In stage 2, we will develop initial programme theories for what makes independent prescribing effective in community pharmacy, for whom, in what circumstances and how. In the third stage, we will conduct literature searches to gather secondary data that will help refine our initial programme theories. In stage 4, we will select and appraise identified articles by screening titles, abstracts and full texts against inclusion and exclusion criteria. In stage 5, we will extract, document and code relevant data, followed by realist analysis with contributions from the PPIE and SG. Stage 6 focuses on refining programme theories and identifying key mechanisms that lead to desired outcomes. PROSPERO registration: CRD42023468451

CTN-0138: adaptation, implementation, and cluster randomized trial of a Community Pharmacy-Based Prescription Drug Monitoring Program Opioid Risk Assessment Tool—a protocol paper

Abstract Background As the opioid epidemic continues to have a major negative impact across the US, community pharmacies have come under scrutiny from legal systems attempting to hold them accountable for their role in over dispensing and lack of patient intervention. While the most available tool for monitoring patients’ opioid use is Prescription Drug Monitoring Programs (PDMP), these do not provide pharmacists with actionable information and decision support. Our study addresses this gap through three objectives: [1] incorporate validated opioid risk metric thresholds into a PDMP platform to create the Opioid Risk Reduction Clinical Decision Support (ORRCDS) tool; [2] assess ORRCDS’ ability to reduce patient opioid risk; [3] assess ORRCDS’ sustainability and viability for broader dissemination in community pharmacy. Methods For objective 1, our team is partnering with leadership from the largest US PDMP organization and a top-five pharmacy chain to implement ORRCDS into the pharmacy chain’s workflow following the Guideline Implementation with Decision Support (GUIDES) framework. For objective 2, our team will conduct a type-1 implementation mixed methods study using a 2-arm parallel group clustered randomized design. We anticipate enrolling ~ 6,600 patients with moderate and high opioid use risk during the 6-month enrollment phase across 80 pharmacies. This sample size will provide 96.3% power to detect a 5% or greater difference in responder rate between the intervention and control arm. Responders are patients with moderate-risk at baseline who reduce to low-risk or those with high-risk at baseline who reduce to moderate or low-risk at 180 days post last intervention. To accomplish objective 3, we will use the Consolidated Framework for Implementation Research (CFIR) to develop and execute cross-sectional qualitative interviews with pharmacists (n = 15), pharmacy leaders (n = 15), and PDMP leaders (n = 15) regarding long term adoption and sustainability of the ORRCDS tool. Conclusions A PDMP tool that addresses moderate- and high-risk opioid use is not available in community pharmacy. This study will implement ORRCDS in a large retail pharmacy chain that will include additional screening and guidance to pharmacy staff to address risky opioid medication use. Our results will make critical advancements for protecting patient health and addressing the opioid epidemic.

Feasibility and Impact of Community Pharmacy and Novel Pick-up Points for Antiretroviral Therapy Pre-exposure Prophylaxis Initiation and Continuation in Low and Middle-income Countries.

This review assesses recent developments in community access to pre-exposure prophylaxis (PrEP) for HIV prevention in low-and middle-income countries (LMICs). It examines literature on differentiated service delivery (DSD) and alternative delivery modes for PrEP, focusing on the role of community pharmacies and novel pick-up points. Key considerations include barriers to access, potential benefits, and strategies for implementation. Challenges to optimal HIV healthcare delivery persist globally, with LMICs facing greater barriers due to resource constraints and structural obstacles. Community pharmacies and novel pick-up points offer promising avenues to expand access to HIV medication, especially in hard-to-reach populations. However, operational complexities and regulatory frameworks present significant challenges. Recent initiatives, such as collaborative practice agreements and programmes by global health agencies, highlight efforts to integrate community pharmacies into HIV prevention and care delivery. Mobile health clinics and home delivery services have also shown promise in improving treatment coverage. Community pharmacies and novel pick-up points play a crucial role in enhancing access to HIV PrEP in LMICs. Despite challenges related to infrastructure, funding, and regulatory oversight, innovative strategies like DSD and mobile outreach offer opportunities to reach marginalized populations. Real-life examples from LMICs demonstrate the feasibility and effectiveness of leveraging community pharmacies for HIV treatment. However, addressing policy gaps, strengthening pharmacist training, and promoting patient-centred approaches are essential for scaling up access to PrEP. Collaboration between governments, health agencies, and local communities is key to realizing the full potential of community pharmacies in HIV prevention and care.

Regulation of mark-up on medicine prices in Zimbabwe: a pilot survey from 92 community pharmacies in the metropolitan area of Harare.

Medicine pricing in the community pharmacy sector in Zimbabwe significantly influences accessibility to health care. In this pilot survey, we investigated how community pharmacies in Zimbabwe apply various mark-up strategies to essential and non-essential medicines, and gathered community pharmacists' perspectives on mark-up regulation. Using an adapted methodology endorsed by the World Health Organization and Health Action International for studying medicine prices and availability, we conducted a quantitative cross-sectional pilot survey for 46 medicines (31 essential and 15 non-essential) identified using the Zimbabwe Essential Medicines List and classified according to the Vital, Essential, and Non-essential (VEN) tool. We conducted the pilot survey in 92 community pharmacies in the metropolitan area of Harare, Zimbabwe. We gathered a total of 92 responses from 167 distributed questionnaires. The most prevalent mark-up strategy was the cost-plus fixed percentage.The median mark-up for all medicines in the community pharmacies was 60% (interquartile range 50- 82%). We found a statistically significant difference in the median mark-up by essentiality of medicines (p < 0.001), essential medicines had a median mark-up price of 62% while non-essential medicines had a mark-up of 56%. Antipsychotics had the highest mark-up at 82%, while anti-neoplastic medicine had the lowest at 36%. Overall, 55% of the community pharmacists did not support mark-up regulation. Mark-up strategies varied across community pharmacies in the metropolitan area of Harare.Without mark-up regulation, essential medicines remain significantly expensive in Zimbabwe. We recommend mark-up regulation in Zimbabwe's community pharmacy sector and emphasize the effective use of multiple pricing strategies to reduce medicine prices. .

Lyme disease chemoprophylaxis prescribing before and after pharmacist prescriptive authority in Nova Scotia

Background: Lyme disease is a bacterial infection transmitted to humans through bites from infected Ixodes species of ticks. Prophylaxis with a single dose of oral doxycycline following a bite from an infected tick reduces the risk of developing Lyme disease. Pharmacists in Nova Scotia (NS) were among the first in Canada to prescribe for this indication. The primary objective of this study is to describe experiences with pharmacist prescribing of prophylaxis after tick bites in NS. Methods: A retrospective cohort study was performed using health administrative data 16 months before and after pharmacists were authorized to prescribe Lyme disease chemoprophylaxis (August 1, 2021). All dispensations of a single dose of oral doxycycline from a community pharmacy in NS were included. Data collected included prescriber type, date, and county of dispensation. Comparisons of dispensations were completed before and after pharmacists gained prescriptive authority and relative to other prescribers. Dispensations were described descriptively. Results: Over the study period, 12,549 single-dose doxycycline prescriptions were dispensed in NS: 3900 prescriptions were dispensed before pharmacist prescribing authorization for this indication occurred and 8649 were dispensed after. Pharmacists prescribed 61.3% of all single-dose doxycycline prescriptions following implementation of prescribing authority. Discussion: An increase in single-dose doxycycline prescriptions was observed in NS. Pharmacists have become the primary prescribers for Lyme disease chemoprophylaxis in the province. Conclusion: Patients were willing to be assessed for chemoprophylaxis after tick exposure by pharmacists, and pharmacist prescribing for this indication suggests increased access to post-tick exposure care.

Factors Associated with the Practice of Assessing Drug–Drug Interactions Among Pharmacists in Saudi Arabia

Background: Drug–drug interactions (DDIs) occur when two or more drugs are administered concomitantly, changing the pharmacokinetics or pharmacodynamics of a drug’s characteristics. Despite the advances in health technology, DDIs remain a concern to patient safety. This study aimed to (1) assess the knowledge, attitude, and practice of hospital and community pharmacists toward DDIs in Saudi Arabia and (2) examine factors associated with their practice. Methods: A cross-sectional study was conducted using an online self-administered questionnaire targeting hospital and community pharmacists working in Saudi Arabia. The study questionnaire consisted of five sections: demographics, knowledge, attitude, and practice toward DDIs, as well as pharmacy characteristics. Descriptive statistics were used to summarize the characteristics of participants as count and percentage. Chi-square tests were used to examine associations between practice variables and other independent variables. Results: A total of 131 pharmacists participated in the study. The majority were males (81.7%), aged 26–35 years (64.9%), and worked in community pharmacies (81.7%). Nearly half of the participants reported optimal practice regarding checking drug interactions before dispensing any drug. Factors associated with the practice of checking DDIs were found to be gender, perceived workload, perceived knowledge, and attitude variables. Regarding the practice of asking patients about their prescription and OTC drugs, there were statistically significant differences between hospital and community pharmacists. Conclusions: Our findings on both community and hospital pharmacists in Saudi Arabia reveal that pharmacists’ attitudes and perceived knowledge might influence the practice of pharmacists toward DDIs.

Qualitative exploration of the barriers and facilitators to community pharmacy PrEP delivery for UK pharmacists and underserved community members using the COM-B model of behaviour change

ObjectivesExpanding delivery of oral pre-exposure prophylaxis (PrEP) to community pharmacies could improve access, aligning well with the UK government’s goals to eliminate new HIV acquisitions by 2030. Using the Capability,...

Pandemic preparedness of Egyptian community pharmacists and potential facilitators to the successful implementation of a community pharmacy coronavirus disease 2019 referral service: a cross-sectional survey.

The coronavirus disease 2019 (COVID-19) pandemic resulted in an increased need for essential community services including new roles for pharmacists. Globally, community pharmacists are a highly accessible point of contact for referral. To assess the preparedness of and facilitators to community pharmacists referring patients with suspected COVID-19 symptoms for testing. A cross-sectional survey was administered using a structured questionnaire to 1023 pharmacists (one respondent in each pharmacy) in Egypt between 17 and 30 May 2020. Pharmacists who had received pandemic referral training were significantly more familiar with the referral system in comparison to those who had not (n = 180; 17.6% vs. n = 841; 82.4%, P = .014). Case referral was significantly associated with the referrer (n = 161, 15.8%), demographics of region (P = .001), graduation year (P = .035), and gender (P = .015). The vast majority of respondents identified facilitators to referring, namely university-level teaching (n = 984, 96.7%), continuing professional development (n = 958, 94.3%), smartphone app (n = 809, 80.5%) or telephone hotline (n = 933, 91.5%), IT access (n = 861, 84.7%), and managing patients' attitudes through the media in terms of the importance of declaring symptoms to (n = 998, 97.7%) and cooperating with (n = 977, 96.2%) referrers. Pharmacists' lack of preparedness to engage with the referral process and related roles contributing to tracking the national COVID-19 infection rate could be mitigated by the provision of facilitators suggested by respondents. These included improved cooperation from local healthcare authorities, educational interventions, technological solutions, and the use of the media. Demographics associated with pharmacists' attitudes to referral, and hence the reliability and validity of the national infection rate, demand further investigation.

Impact of a multifaceted intervention programme on antibiotic prescribing and dispensing in four patient-centred settings in five European countries. The HAPPY PATIENT project.

The primary cause of antimicrobial resistance is excessive and non-indicated antibiotic use. To evaluate the impact of a multifaceted intervention aimed at various healthcare professionals (HCPs) on antibiotic prescribing and dispensing for common infections. Before-and-after study set in general practice, out-of-hours services, nursing homes, and community pharmacies in France, Greece, Lithuania, Poland, and Spain. Following the Audit Project Odense method, HCPs from these four settings self-registered encounters with patients related to antibiotic prescribing and dispensing before and after an intervention (February-April 2022 and February-April 2023). Prior to the second registration, the HCPs undertook a multifaceted intervention, which included reviewing and discussing feedback on the first registration's results, enhancing communication skills, and providing communication tools. Indicators to identify potentially unnecessary prescriptions and non-first-line antibiotic choices were developed, and the results of the two registrations were compared. A total of 345 HCPs registered 10 744 infections in the first registration period and 10 207 infections in the second period. In general practice, participants showed a significant 9.8% reduction in unnecessary antibiotic prescriptions in the second period, whereas limited or no effect was observed in out-of-hours services and nursing homes (0.8% reduction and 4.5% increase, respectively). Pharmacies demonstrated an 18% increase in safety checks, and correct advice in pharmacies rose by 17%. External factors like COVID-19, antibiotic shortages, and a streptococcal epidemic impacted the intervention's benefits. Despite this, the intervention successfully improved antibiotic use in both settings.

Identifying legitimate websites selling medicines in South Africa

Background: The online sale of medicines has skyrocketed globally, where medicines are purchased in the comfort and privacy of one’s own home. However, there are an increasing number of illegal websites selling counterfeit and falsified medicines.Aim: The aim of this study was to review the information and medicines sold online through pharmacy websites in South Africa (SA) and their compliance with local legislation.Setting: The study setting comprised online pharmacy websites in SA.Methods: This quantitative descriptive study used a purposeful questionnaire based on the South African Pharmacy Council inspection questionnaire for pharmacies operating websites. Websites claiming to be an online pharmacy in SA were included.Results: There were 25 websites reviewed, which claimed to be online pharmacies. Majority (n = 22) were found to be legal websites, operated by a registered community pharmacy and required a prescription for the purchase of prescription only medicines. Few websites complied with legislation such as displaying the Y number (n = 5) and name of the responsible pharmacist (n = 10). The remaining three websites were not linked to physical pharmacies, none complied with legislation and supplied medicines without a prescription.Conclusion: Although the online sale of medicines is regulated in SA, not all websites complied with legislation. The study highlighted the importance of monitoring websites claiming to be online pharmacies and their compliance with legislation.Contribution: Four stakeholders, consumers; pharmacy websites; regulators and healthcare providers, were identified and their role outlined in promoting the safe online purchasing of medicines.

Knowledge, Attitude, and Practice Regarding Dietary Supplements: Community Pharmacies -Based Cross-Sectional Study in Yefren, Libya

Dietary supplements (DS) are the most prevalent subcategory of complementary and alternative medicine (CAM), which is a classification of a variety of healthcare and medicinal items that aren't typically included in standard medications. The aim of the study is to assess the knowledge, attitude, and practice of Yefren community pharmacies (Libya) about dietary supplements. Methods: A cross-sectional study was designed to collect responses from 100 participants in community pharmacies in Yefren in March 2024 through a knowledge, attitude, and practice (KAP) survey. Result: This study used a validated questionnaire consisting of four parts, knowledge, attitude, and practice regarding dietary supplements. Conclusion: all the participants in the community pharmacies in Yefren had good knowledge, attitude, and practices for dietary supplements.

Quality Management in Spanish Community Pharmacy: Implementation of ISO 9001.

Spanish community pharmacy has been incorporating some methods and approaches in the evaluation and improvement of quality, with the ISO 9001 standard being the most used reference. The experience of a community pharmacy in Spain is presented. The pharmacy implemented a management system based on the ISO 9001 standard in 2020, using the Deming cycle with the aim of enhancing the quality of pharmaceutical care. The results obtained in the processes over the following 2 years are also presented. The ISO 9001 standard was reviewed to ensure compliance. The Quality Management System control documentation was updated and included the following documents: quality manual, process map, operational processes and procedures, quality indicators and incident records. The pharmacy has planned and implemented a process of monitoring, measurement, analysis of results and continuous improvement for operational, strategic and support processes during the time period of the study. The main operational processes were associated with a set of indicators which permitted to know the results obtained, analyse deviations and implement improvements. The planning and development of the project encompassed approximately 1 year and involved several key stages: (1) diagnosis and assessment of quality situation, (2) analysis of processes, (3) preparation of documentation, (4) implementation of the Quality Management System, (5) internal audit, (6) monitoring of activities and continuous improvement, (7) follow-up audit by the certifying body, (8) obtaining the ISO 9001:2015 quality certificate. The planned schedule was adhered and the documents were successfully drafted. In total, eight operational processes, nine support processes and six strategic processes were reviewed and included in the Quality Management System. Twenty indicators were established to monitor and analyse the performance of these processes. During audits, deviations in the system or nonconformances were identified and analysed. In the first year of system implementation, five nonconformances were identified, decreasing to two in the subsequent two periods. In 2020, three improvement actions were implemented with the objective of: (1) implementing a medication reconciliation service, (2) developing a medication dose adjustment service for polymedicated patients, and (3) implementing a service to measure and improve inhalation technique in patients using inhalers. The implementation of a methodology based on the ISO 9001 standard has facilitated: (1) Integrating process management as a regular working methodology, (2) A focus on the continuous improvement of services, (3) Achieving recognition of the staff efforts and involvement.

Rural pharmacist and consumer perspectives of expanded pharmacy services to address inequity in accessing health services.

Australians living in rural and remote communities have inadequate access to health services, contributing to poorer health outcomes compared to their metropolitan counterparts. This study investigated consumers' and pharmacists' perspectives of expanded pharmacy services in rural and remote communities in Australia. It aims to identify the role of the pharmacist in addressing the inequity of access to healthcare through the provision of expanded services in rural and remote practice. A concurrent parallel mixed-methods study was undertaken in rural Western Queensland, Australia to include a survey of 167 consumers and in-depth interviews with 10 pharmacists. Quantitative data analysis employed descriptive statistics and chi-square tests, while qualitative data were analysed thematically against the constructs of the Diffusion of Innovations Theory. Consumers indicated that they would like to access weight management services (53%), whereas pharmacists thought it was important to offer respiratory clinics and services. Both pharmacists and consumers would like to see diabetes checks (30% and 56%, respectively) and vision, hearing, and ear checks (40% and 53%, respectively) implemented as services in community pharmacies. Most consumers (97%) believe pharmacists have the skills and knowledge to deliver expanded services and in doing so, they would improve the overall health of the community. Pharmacists reported staffing availability, workload and time constraints, cost, and jeopardizing inter-professional relationships as barriers to implementing expanded services. Consumers were supportive of pharmacists working to their full scope of practice to provide expanded services, whereas pharmacists, while open to the idea, highlighted that there were barriers to overcome.

‘It's not just a matter of taking the drug. It's about changing the way you function in your society too’: Narratives of power and resistance in the lived experiences of opioid agonist therapy consumers in regional Victoria, Australia

Opioid Agonist Therapy (OAT) has initiated extensive discussion regarding its efficacy, cost-effectiveness and best practice delivery. Although this discussion has been dominated by pharmacologists, clinicians, pharmacists and public policy-makers, there is increasing interest in examining OAT consumer experience and voice, particularly regarding consumers’ navigation and experience of the social field of their treatment. Concerned with the expression and circulation of power and resistance, Michel Foucault's work offers rich resources for examining OAT consumers’ experience and navigation of the social field of their treatment, including the administration of OAT as a harm reduction and social welfare intervention and consumers’ efforts to shape their relationships with medical and allied health professionals and other stakeholders. In the case of this study, Foucault's conceptions of power provide a productive means to critically interrogate the experience of 16 OAT consumers participating in pharmacotherapy treatments within a community pharmacy model in regional Victoria, Australia. Through the application of Foucauldian analyses of subjects and power to OAT participant accounts, precisely what the participant responses in our study have shown is that the relationship between OAT practitioners and consumers is neither always oppositional nor binary. Findings suggest that practitioners must pay attention to the everyday interactions they have with consumers (and others)—to how they communicate, listen, understand, present and provide solutions. Interactions with consumers should be treated as sites that produce complex power relations with moral and ethical implications for subjects, including consumers, practitioners and other stakeholders. Both practitioner and consumers need to remember that they are both productive subjects locked in a complex assemblage of practices and social discourses that circumscribe the social field of opioid treatments.

Clinical outcomes following acute sore throat assessment at community pharmacy versus general practice: a retrospective, longitudinal, data linkage study.

To date, no research has compared longer-term outcomes (antibiotic provision; re-consultations; hospital admissions for quinsy; cost-effectiveness) following presentation with acute sore throat at general practice (GP) versus newer, pharmacy-led services. A retrospective, longitudinal cohort study of sore throat consultations between 1 November 2018 and 28 February 2020 either with the Wales pharmacy-led sore throat test and treat (STTT) service or with a healthcare professional at GP. Individual-level pharmacy consultation data from the national Choose Pharmacy IT application were securely uploaded to the Secure Anonymised Information Linkage Databank and linked to routinely collected, anonymized, population-scale, individual-level, anonymized health and administrative data. Of 72 736 index consultations, 6495 (8.9%) were with STTT and 66 241 (91.1%) with GP. Antibiotic provision at the index consultation was 1382 (21%) with STTT and 25 506 (39%) with GP [adjusted odds ratio (AOR), 0.30; 95% CI, 0.27 to 0.32]. Antibiotic provision within 28 days of index occurred in 1820 (28%) STTT and 26 369 (40%) GP consultations (AOR, 0.44; 95% CI, 0.41 to 0.47). GP re-consultation rate within 28 days of index date was 21% (n = 1389) with STTT compared with 7.4% (n = 4916) with GP (AOR, 3.8; 95% CI, 3.5 to 4.1). Coding limitations may lead to overestimates of GP re-consultations rates in the STTT group. Hospital admissions for quinsy were rare in both STTT (n = 20, 0.31%) and GP (n = 274, 0.41%) (AOR, 0.68; 95% CI, 0.43 to 1.1). STTT was less costly than consultation with GP. The pharmacy-led STTT service is safe, cost-effective, and contributes to antimicrobial stewardship.

Knowledge Gaps Regarding Allergic Rhinitis among the Patients Visiting Community Pharmacies of Lahore, Pakistan

Introduction: Allergic rhinitis is a varied disorder characterized by symptoms such as sneezing, nasal blockage, nasal itching, and a runny nose. This study assessed the knowledge of patients about Allergic rhinitis and to identify knowledge gaps in patient’s understanding along with the factors that may impact knowledge regarding the disease. Methods: A cross-sectional observational study design was implemented to collect data from patients visiting community pharmacies of Lahore on a structured questionnaire (self-developed) containing 12 items related to knowledge. The questionnaire was distributed to physician diagnosed Allergic rhinitis patients. The questionnaire with closed-ended questions was completed by 240 participants of both genders as sampled through random sampling procedure. The study spanned over a period of eight months. Results: Among 240 respondents, 81.3% were students and majority were female (58.3%). It revealed that only 33.3% of respondents demonstrated adequate knowledge about Allergic rhinitis, while 66.7% demonstrated inadequate knowledge. Among demographic variables, female respondents presented better knowledge compared to the male population. Moreover, education status was positively associated with knowledge of respondents. Low education status of study subjects was observed to be the reason for knowledge gap among respondents. The p-values&lt;0.05 were considered statistically significant. Conclusion: This study highlights a significant gap in respondent’s knowledge, emphasizing the need for targeted education and intervention. Low literacy rate was the major factor negatively associated with respondents’ knowledge of Allergic rhinitis. Improved knowledge is crucial to promoting good practices and achieving desired outcomes. Educational interventions and seminars should be conducted at public health sectors to enhance awareness in the general population.

Education on antimicrobial stewardship in community pharmacies to be delivered as a part of a public health campaign

Abstract Introduction Community pharmacies are well-placed to educate the public on antimicrobial stewardship (AMS). Medicines management teams have historically focused on empowering prescribers to practise prudent use of antibiotics; in 2017 there was a lack of education/support to community pharmacy (CP) colleagues on the same topic, although subsequent ESPAUR reports (2) have highlighted the tools and resources that are now available to CP. To address the identified need locally, educational events for CP staff were organised with the aim of increasing knowledge of AMS and increasing confidence in recommending self-care for self-limiting respiratory tract infections (RTIs). Educational material delivered included key AMS messages, an introduction to the local antimicrobial guidelines and a case study. Method In the UK, a Birmingham based commissioning organisation organised a CP public health (PH) campaign promoting AMS. The campaign ran throughout February 2017. All CPs in Birmingham and Sandwell (n=385) were invited to an educational event, with 4 dates through January. The event provided educational presentations on AMS, including fundamentals of antimicrobial resistance (AMR), and management of self-limiting RTIs, with interactive case studies focussing on patients who may initially present to their local pharmacy. Content was delivered by a consultant microbiologist and the antimicrobial lead pharmacist. Learning outcomes included understanding of AMS, AMR, appropriate antibiotic use, and the role of a CP team in raising public awareness. An electronic questionnaire was designed and provided to CP via PharmOutcomes after the campaign, to assess the impact of the events on the knowledge and confidence of the staff in delivering key AMS messages to the public. All responses were completed at the same time after the education session and this may impacted the results. The follow up questionnaire was classed as service evaluation by the organisation as per the NHS Health Research Authority assessment tool and did not require ethical approval. Results There were 226 responses to the questionnaire, from 210 (54.5%) CP. Of the 150 spaces available for the educational events, 144 tickets were reserved. Prior to the session 26% (n/58) of CP staff felt their knowledge of AMS was very good or excellent; after the session this increased to 78% (n/177). Confidence in recommending self-care for self-limiting RTIs also increased, with 79.2% (n/179) rating their confidence as very good or excellent after the session compared to 36.3% (n/82) beforehand. 95% (n/214) of CP staff felt that the education session changed their attitude towards AMS. Discussion / Conclusion This intervention showed a positive outcome of increasing CP knowledge about AMS and confidence in recommending appropriate self-care. The educational events were well attended although not all pharmacies were able to engage with the events and not all the learning outcomes were able to be captured in the evaluation survey. Overall feedback from CP was positive with the majority of staff gaining an increase knowledge and confidence in communicating with the public and recommending self care where appropriate. As the questionnaire was anonymised, we were unable to follow up feedback from individuals, which have useful to inform future sessions.

How do people use community pharmacies to manage sleep problems? A cross-sectional survey of pharmacy customers in England, UK

Abstract Introduction Insomnia and sleep problems have become increasingly common in the UK population, with research indicating a rise in the prevalence of sleep issues and the use of hypnotic medications1. Poor sleep can severely affect overall health and has been linked to cardiovascular disease, type 2 diabetes, and other conditions2. Community pharmacies are ideally positioned to advise people about sleep, but there is limited information about how people currently utilise them for sleep problems. Aim To understand how people use community pharmacies to manage problems with sleep Methods A researcher-administered questionnaire with customers at 16 community pharmacies in the East Midlands from the 6th to 25th of March 2023. People aged 18 and older were approached to take part. Survey questions included demographic information, general pharmacy use, and specific questions related to health-seeking advice for sleep problems. Responses were recorded using the Qualtrics survey platform and descriptive statistics derived using MS Excel. Ethical approval was given by the School of Pharmacy Research Ethics Committee at the University of Nottingham (2017-017er). Results 13,127 customers were approached to take part, and 4,985 consented and completed the questionnaire (response rate = 38.0%). Two thirds of participants were female (66.3%), half were above the age of 50 years (51.1%), and the majority identified as white ethnicity (79.8%). Just under one-third of participants reported purchasing a medicine, herbal remedy, or other product to help with sleep in the past (28.2%), of which 81.8% had purchased from a community pharmacy. The most common medicines purchased were anti-histamines (43.7%), followed by herbal remedies (34.1%). Only 19.1% of participants had previously sought advice for a sleep problem, of which 64.9% had sought advice from a GP/other healthcare professional, and 29.2% had sought advice from a community pharmacy. The most common advice received from a community pharmacy was to use a medicine (32.2%), with the second most common being sleep hygiene/lifestyle advice (22.8%). The most common advice received from a GP was also to use a medicine (36.4%). Discussion / Conclusion A significant proportion of survey participants reported purchasing a medicine, herbal remedy, or other product to help with sleep from a community pharmacy, highlighting the significant role of pharmacies in managing sleep issues. However, considerably fewer customers had sought advice for their sleep problem, identifying a potential gap in care. Current national guidelines do not recommend medication as first-line treatment for insomnia, emphasising sleep hygiene and behavioural therapy, with no role for sedative anti-histamines3. Despite this, our survey indicated the most common advice focused on medicines. This suggests an opportunity for enhancing the education of healthcare professionals and improving public awareness of managing sleep problems. Whilst this survey involved a large number of participants, we recognise it may not be fully representative of the wider UK population or practice. Further analysis of this survey and interviews with customers and pharmacists would help understand how the role of community pharmacies in managing sleep could be further developed to improve care.

Assessing the impact of a leadership development programme on self-reported confidence of Community Pharmacy Neighbourhood Leads in South East London

Abstract Introduction Community Pharmacy (CP) integration is a key NHS England strategy, including for South East London (SEL) Integrated Care Board (ICB). To drive forward this strategy in SEL, the ICB medicines team created and funded community pharmacy neighbourhood lead (CPNL) roles. The CPNLs provide local leadership to strengthen CP-GP relationships and increase uptake of CP services (now badged Pharmacy First). To support implementation, a leadership programme was developed with system partners and delivered by Kaleidoscope,1 building on previous work.2 Core themes were building trust, driving collaboration and embedding innovation. Aim To measure the confidence level of CPNLs in SEL throughout the development programme, and associated outcomes. Methods There were five leadership sessions delivered to invited CPNLs and ICB colleagues between November 2023 and March 2024. The first and last sessions were face-to-face with the others virtual. Sessions covered both theory and implementation. At the end of each session all participants were asked to complete an online Microsoft forms survey compiled by Kaleidoscope, asking about their confidence in the CPNL role (where 1 is not at all confident and 5 is extremely confident), current relationships locally and actions planned and completed to date, using tick box, Likert scale and free text responses. Data was analysed in Microsoft Excel and through content analysis, with analysis completed for all attendees per session and separately for those attending 4 or 5 sessions. This study received ethics approval from Kingston University Ethics Committee (3396). Results A total of 37 individuals attended one or more sessions, with 16 attending 4 or 5 sessions. For all attendees, mean confidence score increased from 3.7 in session one to 4.14 in session five (out of 5) (session two:3.77; session three:4.05; session 4:4.17). Those who attended four or five sessions finished with a mean confidence score of 4.33, starting at 4.00 (session two:3.86; session three:4.19; session four:4.27). Comments showed participants initially reporting that there was room to improve relationships with key stakeholders, such as clinical directors, GPs, ICB and CP colleagues. By session five confidence had increased with comments noting that there was confidence to meet new people, network appropriately, and fulfil the required role. ‘Through the network we have created through this programme, confidence has grown with shared learning and new relationships.’ Comments were also received relating to improved joint working supporting the rollout of community pharmacy initiatives such as the Pharmacy First scheme. ‘Our confidence has grown, and we are arranging training sessions with the clinical directors with the local surgeries for some of the newer services like Pharmacy First.’ Discussion / Conclusion Our programme has increased CPNL confidence and engagement with local stakeholders, with greater confidence seen in those engaging most with the leadership programme. Limitations include not having consistent attendance at sessions. The launch of the national ‘Pharmacy First’ service halfway through the programme had a significant impact on the community pharmacy sector,3 with CPNLs being pivotal in building success in partnership. Further evaluation should assess impact of CPNLs on community pharmacy service provision and referrals by GPs.

Survey to identify barriers and enablers to implementation of genomics in pharmacy practice across healthcare sectors in a rural community

Abstract Introduction The potential for genomics to improve patient outcomes is being harnessed via national strategy to embed genomic testing into NHS practice, and drive use of precision medicines and pharmacogenomics1. The national pharmacy genomics education and training strategic framework aims to empower the pharmacy workforce, across all sectors, to use genomics to support medicines optimisation2. Cornwall, a rural and coastal county, has areas of marked deprivation with poorer health outcomes3 and challenges in recruiting and retaining healthcare professionals. It is key that rural/coastal communities have equitable access to genomic services and expertise to avoid exacerbating pre-existing health inequalities. Aim To identify barriers and enablers to the implementation of genomics into pharmacy practice in a rural community. Methods Pharmacists and pharmacy technicians working in Cornwall were eligible to participate. An anonymised survey was compiled via Microsoft Forms of closed, multiple choice and optional open questions. Following piloting, the survey link was disseminated via email by pharmacy leaders in community pharmacy, primary and secondary care in May 2024. Responses were stored securely via NHS password protected IT systems and analysed via quantitative and thematic analysis. As this project is defined as a service evaluation, according to the UK NHS Health Research Authority, ethical approval was not required. Results Fourteen pharmacists and 7 pharmacy technicians participated, from primary and secondary care and community hospitals, with no participants from community pharmacy. Seven had received prior training in genomics (teaching sessions (n=5), webinars (n=1), podcasts (n=1), articles in journals (n=2)). One participant had received formal undergraduate training. Key barriers to the implementation of genomics included a lack of education and training (n=5), perceived cost of genomic testing (n=2), difficulty in accessing genomic services (n=1) and lack of expert panels (n=1). It was also felt that genomics services were limited to secondary/tertiary care (n=2). Respondents stated that the rural location impacted the availability of face-to-face training and resources to support training (n=17). Key enablers were the opportunity for precision prescribing (n=8), and improved patient outcomes (n=7). Genomics education and training (n=5) and resources to support training (n=11) were viewed as being pivotal to supporting the mainstreaming of genomics. Discussion and conclusion Participants were keen to further their genomics knowledge, with a preference for face-to-face training. Respondents also highlighted the need for allocated resources to support training. As emphasised in the strategic framework2, workforce upskilling is vital to the successful mainstreaming of genomics, particularly when the majority of pharmacy staff had not received any formal training. There were no participants from community pharmacy, indicating a requirement to further explore barriers and enablers in this cohort. Community pharmacy staff may be reluctant to participate if they perceive genomics to relate solely to secondary/tertiary care. Survey methodology also limited the detail that could be obtained from respondents. This provides helpful preliminary insights on barriers and enablers to genomics implementation into pharmacy practice in rural/coastal areas. Themes could be further explored via semi-structured interviews, with the aim of shaping interventions necessary to ensure equitable provision of genomics services and expertise to these communities.